There is nothing comparable to the feeling you get when that first pregnancy test comes back positive. If you’ve been hoping for children the joy, excitement, and twinge of change-averse panic can be overwhelming. If you’ve been trying to conceive for a while, you’ve probably got waves of relief crashing over you, as well! You’re (perhaps finally) pregnant! Then, when you go to your doctor for your clinical pregnancy test (the blood test), your hCG levels aren’t quite where they need to be. What next?
What, exactly, is a biochemical pregnancy?
A biochemical pregnancy is when the initial pregnancy test is positive, but the subsequent follow up clinical pregnancy blood test doesn't have the expected increase in bHCG levels. A biochemical pregnancy therefore does not progress to a clinical pregnancy.
Cristina Vidal, Stanford IVF nurse explains, “some patients have many questions such as ‘Am I pregnant’ or ‘Is this a false positive pregnancy test?’. It is very hard to explain to patients. The pregnancy test may have detected an early pregnancy showing an early implantation that started, but failed to continue progressing. Oftentimes, such biochemical pregnancies go unrecognized.”
Biochemical pregnancy vs. clinical pregnancy
In a biochemical pregnancy, hCG levels decline over time after repeated blood tests and the pregnancy is only detected biochemically — it cannot be visualized on an ultrasound. Some doctors characterize this as an “early miscarriage.”
A clinical pregnancy is when the pregnancy has reached a stage that the gestational sac can be seen by ultrasound. It is important to understand, however, that a clinical pregnancy does not always result in a birth. Miscarriages do happen. These pregnancies are called “clinical” pregnancies because their initial stages can be confirmed visually on an ultrasound, unlike a biochemical pregnancy.
What do I do if I have a biochemical pregnancy?
It can be disappointing and stressful to see hCG levels going down after repeated tests. Unlike an ectopic pregnancy, there’s no treatment needed for a biochemical pregnancy.
This is hard to answer, because “really pregnant” is something that you will have to decide on your own. You did conceive. Your egg was fertilized. For some, that is what makes them pregnant. In that sense, your test was correct.
For others, because the embryo fails so early on, and the clinical conditions weren’t met to return a positive pregnancy result with a blood test or ultrasound, they don’t feel as attached to it as others do and feel that their first pregnancy test returned a false positive, which—to be fair—does sometimes happen.
The most important thing to understand is that you did nothing wrong. There was nothing you could have done between conception and implantation that would have ensured a different outcome. This result was not your fault.
In fact, it might be helpful to see it as a sign that you are able to conceive given implantation of an embryo is possible and that there’s a chance for a healthy pregnancy in the future. Your next step is to work with your doctor to figure out next steps for helping improve your chances for carrying a clinical pregnancy to term the next time (if you choose to try again) you conceive.
